This topic comes by request on the Savvy Psychologist Facebook page from listener Anita M. of Detroit.  Anita works with foster kids and, too often, sees disadvantaged kids who have been on a cocktail of psychiatric medications from as early as age 6.  She asks, does such early use alter a child’s brain or body?  And have the effects of lifelong psychiatric medication been studied?

Childhood mental illness (and resulting medication) is equally overblown and under-recognized.  Approximately 21% of American kids - that’s 1 in 5 - will battle a diagnosable mental illness before they reach the age of 17, whether or not they actually get treatment.  

The problem is anything but simple.  Some childhood illnesses - ADHD and autism, for example - often get misused as “grab-bag” diagnoses when something’s wrong but no one knows what. This leads to overdiagnosis and sometimes, overmedicating. Other illnesses, like substance abuse, get overlooked or written off as rebellion or experimentation, leading to underdiagnosis and kids slipping through the cracks.

But the most common problem is inconsistent diagnosis.  For example, a 2008 study found that fewer than half of individuals diagnosed with bipolar disorder actually had the illness, while 5% of those diagnosed with something completely different actually had bipolar disorder.  

But let’s get back to Anita’s questions: Does early psychotropic medication alter a child’s brain?  The short answer is yes, but the long answer might be different than you think.

A 2012 review from Stanford researchers analyzed over 50 studies that used neuroimaging - that is, MRI, fMRI, magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), and anything else that takes before-and-after pictures of the brain - to examine the brains of kids with a variety of mental illnesses: anorexia, ADHD, autism, bipolar disorder, depressionOCD, and schizophrenia.  They found that overall, medication does indeed affect brain structure and function to a degree detectable by imaging.

But probably not in the way you expect.

Do Psychiatric Drugs Alter the Brain?
Usually, when we think “brain changes” we think it means something bad, like damage or stunting. But it’s important to remember that untreated mental illness can also harm brain development. Early medication can help prevent the illness from getting worse or becoming neurally entrenched.  

Let’s look at the anorexia group, for example.  Before medication and therapy, teenagers with untreated anorexia displayed different brain activation than a control group, but after 7 months of treatment, the differences disappeared.  As the anorexic group regained weight and got better, their brains changed to be more like “normal.”

Likewise, a 2012 study on kids and adults with ADHD revealed that, over time, treatment has a positive effect on brain structure.  As a group, kids who received treatment had fewer brain structure abnormalities than those who were left untreated.

Now, does all this mean it’s acceptable to put 6-year-olds on antipsychotics?

The answer?  We don’t know.  

But it’s no coincidence that medication overload starts at age 6, because this is when kids start school.  When one child constantly disrupts the learning of 20-30 others, medication unfortunately can get called in as a neutralizing ray.

But, just like adults shouldn’t substitute coffee for sleep, or alcohol for relaxation, psychiatric medication should never be a substitute for teaching kids self-regulation, dealing with a stressful family situation, or to sedate a child who is causing problems.  

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